experityhealth.com | Issue 08 Winter 2019 Urgent Care Trends: A Five-Year Retrospective Issue 08 Winter 2019 Urgent Care Trends: A Five-Year Retrospective An Experity Publication The Annual Report Edition
About the Urgent Care Quarterly
Data drives today’s business decision-making. On-demand healthcare is no exception. Urgent care organizations and providers increasingly rely on data and analytics to inform their practice, improve care, and lower costs, in an effort to deliver a value-based, patient-focused, and cost-effective urgent care experience. It’s not the future—it’s today.
Experity provides reliable urgent care data. Much of the available data has a small sample size, is self-reported, or is not relevant to the urgent care industry. This is where we come in. With urgent cares partnering with us more than any other EMR/PM solutions company—combined with our software’s capabilities to look at data in powerful ways—we can present discrete, aggregated data specifically as it relates to urgent care. Our goal with Urgent Care Quarterly is to support the industry with data-rich articles and to explain it in meaningful ways that help you make smart business decisions.
NOTE:
This resource was first published prior to the 2019 merger between DocuTAP and Practice Velocity. All data analyzed for this publication was pulled from DocuTAP’s database.
The Annual Report Edition
Urgent Care Trends
January 1, 2014 – December 31, 2018
From provider megamergers to increased patient convenience, 2018 was a remarkable year for urgent care. We saw upsurges and downturns in the performance benchmarks that help to keep providers on track. In this special Annual Report Edition, we dive into last year’s urgent care data and stack it up against performance data for key metrics over the last five years to guide your growth and set your sights on success—by the numbers.
Urgent Care Trends: A Five-Year Retrospective
Visit Volume
As urgent care becomes an emergency department alternative and preferred healthcare choice for an increasing number of non-emergent patients, it stands to reason that eventually we will reach a tipping point as growing supply meets the growing demand. Are we getting any closer to that place?
We looked at urgent care visit volume over five years and found only slight fluctuations in average visits per clinic per day, year over year. Urgent care visits are by far the most common visit class (92 percent of visits), when compared to OccMed (5 percent) and Workers’ Comp (3 percent) visits.
Visits Per Clinic Per Day
Average Visits Per Clinic Per Day Year Over Year
Average Visits Per Clinic Per Day by Visit Class Year Over Year
Average Visits Per Clinic Per Day by Region Year Over Year
On average over the past five years, mature* clinics saw 33.41 visits per day. During that same time, the highest average visits per clinic per day was 33.65 in 2017 and the lowest average was 32.76 in 2016. Over the last five years, non-mature clinics saw an average of 19.12 visits per day, ranging from 18 in 2014 to 20.44 in 2017.
NOTE:
*Mature clinics include all clinics open for more than 12 months. Non-mature clinics include clinics that have been open for less than 12 months.
IN THIS SECTION
FIGURE A. Average
Year Over Year
Issue 08 Winter 2019 40 35 30 25 20 15 10 5 0 33.41 18 2014 33.37 2015 18.65 32.76 19.12 2016 33.65 20.44 2017 33.24 18.57 2018 Mature Non-Mature
Visits Per Clinic Per Day Year Over Year
Urgent Care Trends: A Five-Year Retrospective
For mature clinics, urgent care visits made up the overwhelming majority of visits with an average of 30.56 per day over five years, compared to OccMed with 1.7 average visits per day and Worker’s Comp with 1.01 average visits per day.
Average Visits Per Clinic Per Day by Region Year Over Year
On average over the past five years, mature urgent care clinics saw 33.41 visits per day. The Northeast saw the highest average with 36.31 visits per day followed by; the Southeast with 33.99; the Midwest with 32.91; the West with 31.83; and the Southwest with 28.83.
FIGURE B.
Urgent Care OccMed Workers’ Comp 2014 2015 2017 2016 2018 35 30 25 20 15 10 5 0
Average
FIGURE C.
2014 2015 2016 2017 2018 Midwest Northeast West 5-Year Avg. 33.41 Visits 40 35 30 25 20 15 10 5 0 Southeast Southwest
Issue 08 Winter 2019 Midwest Northeast West Southeast IL IN IA KS MI MN MO NE ND OH SD WI CT DE ME MD MA NH NJ NY PA RI VT AK CA CO HI ID MT NV OR UT WA WY AL AR FL GA KY LA MS NC SC TN VA WV Southwest AZ NM OK TX
Urgent Care Trends: A Five-Year Retrospective
Door-to-Door and Wait Times
Healthcare consumers today are looking for more than a diagnosis. In addition to quality care, they want to get in to see a provider when it’s convenient, and get out fast. Average door-to-door and wait times help us gauge just how well we’re meeting the changing needs of patients. We looked at these metrics over five years.
Wait
Over the past five years, the average urgent care door-to-door time was 64 minutes. There was a big drop between 2014 and 2015 when average door-to-door time dropped from 69 to 64 minutes. Since that time, door-to-door time has remained steady at 63 or 64 minutes.
IN THIS SECTION Average Door-to-Door
Year
Average
Time
Over Year
Wait Times Year Over Year Average Door-to-Door and
Times by Region 2014–2018
FIGURE D. Average Door-to-Door
Year Over Year
Time
Issue 08 Winter 2019 80 70 60 50 40 30 20 10 0 Minutes 2014 69 2015 64 2016 64 2017 63 5-Year Avg. 64 Mins. 2018 63
Average Wait Times Year Over Year
Urgent Care Trends: A Five-Year Retrospective
Over the past five years, the average urgent care wait time was 20 minutes. The longest average wait time was 23 minutes in 2015. The shortest average wait time was 18 minutes in 2018.
Average Door-to-Door and Wait Times by Region 2014–2018
On average, door-to-door time has decreased since 2014 overall and in each region. The Northeast had the shortest door-to-door time—about 55 minutes on average over the last five years. The West had the longest door-to-door time, about 69 minutes on average over the last five years. During that same time, wait time has been fairly steady with an average of 20 minutes across all regions.
The Southwest and the West have been consistently over the annual average and have had the longest wait times with an average of 28 and 24 minutes, respectively. It's important to note that a higher wait time alone does not always result in a higher door-to-door time.
25 20 15 10 5 0 Minutes 2014 20 2015 23 2016 20 2017 20 2018 18 5-Year Avg. 20 Mins. Wait Time Visit Time W 24 min 45 min 69 min SW 28 min 37 min 65 min Door-to-Door Time SE 19 min 47 min 66 min NE 17 min 38 min 55 min MW 16 min 48 min 64 min
FIGURE E.
FIGURE F.
Issue 08 Winter 2019
Urgent Care Trends: A Five-Year Retrospective
Reimbursement per Visit by Month and Region
Comparing your clinic’s average reimbursement per visit to that of competitors and industry leaders is the first step to creating a strategy for success. The second step is exploring the reasons your numbers are either higher or lower than the industry average, and making any necessary changes. We looked at urgent care reimbursement over the past five years to identify trends by month and by region.
The five-year average reimbursement by visit was $124. In 2018, urgent care clinic average reimbursement per visit was the highest, at $126.
IN THIS SECTION Average Reimbursement Per Visit Year Over Year Average Reimbursement Per Visit
Per Visit Trends
Visit
Monthly Trends 2014–2018 Average Reimbursement
by Region Year Over Year Average Reimbursement Per
by Region 2014–2018
FIGURE G. Average Reimbursement Per Visit Year Over Year $130 125 120 115 110 105 100 5-Year Avg. $124 2014 $ 122 2015 $ 124 2016 $ 122 2017 $ 125 2018 $ 126
Issue 08 Winter 2019
Urgent Care Trends: A Five-Year Retrospective
Average Reimbursement Per Visit Monthly Trends 2014–2018
Average Reimbursement Per Visit Trends by Region Year Over Year
Over the past five years, average reimbursement per visit by month shows a variance of around $5. The lowest average reimbursement per visit by month was in August ($122). January and December were the highest ($126).
Over the past five years, average reimbursement per visit was lowest in the Midwest ($114) and highest in the West ($133). The difference between the lowest region and the highest was $37 in 2014, but has steadily decreased to a $15 difference in 2018.
FIGURE H.$130 125 120 115 110 105 100 Jan 126 Feb 125 Mar 124 Apr 123 May 123 Jun 123 Jul 124 Aug 122 Sep 123 Oct 123 Nov 124 Dec 126 Reimbursement Amount $150 140 130 120 110 100 90 80 2014 2015 2016 2017 2018 Midwest Southeast Northeast Southwest West
FIGURE I.
Issue 08 Winter 2019
J. Average Reimbursement Per Visit by Region 2014–2018
Urgent Care Trends: A Five-Year Retrospective
The West had the highest average reimbursement over the last five years at $133 per visit. The Midwest was the lowest at $114 per visit.
$ 133 $ 132 $ 125 $ 123 $ 114
FIGURE
08 Winter 2019 Midwest Northeast West Southeast IL IN IA KS MI MN MO NE ND OH SD WI CT DE ME MD MA NH NJ NY PA RI VT AK CA CO HI ID MT NV OR UT WA WY AL AR FL GA KY LA MS NC SC TN VA WV Southwest AZ NM OK TX
Issue
Urgent Care Trends: A Five-Year Retrospective
E/M Coding Reimbursement
and Distribution
Accurate coding can positively affect your profitability. We looked at reimbursement by E/M code to find the common threads for new and established visits.
The five-year average reimbursement across all E/M codes for new visits was $136 per visit, $115 for established visits, and $124 for an overall average.
IN THIS SECTION Average Reimbursement Per Visit by E/M Code 2014–2018 Percent of Total Visits by E/M Code 2014–2018
Issue 08 Winter 2019
FIGURE K. Average Reimbursement
by E/M
1 2 3 4 5 Reimbursement per Visit $83 $40 $101 $66 $123 $90 $160 $121 $215 $148 New Visit Established Visit $250 200 150 100 50 0 E/M Code
Per Visit
Code 2014–2018
Urgent Care Trends: A Five-Year Retrospective
Over the last five years, level 3 was the most common E/M code for new visits (56%). The most common E/M code for established visits was level 4 (77%). E/M levels 3 and 4 account for more than 90 percent of all urgent care visits.
Winter
Issue 08
2019
FIGURE L.
90% 80 70 60 50 40 30 20 10 0 % of Total Visits 1 0 0 2 1 5 3 19 56 4 77 38 5 3 1 New Visit Established Visit E/M Code
Percent of Total Visits by E/M Code 2014–2018
Issue 08 Winter 2019
Urgent Care Trends: A Five-Year Retrospective
Front Desk Collections Year Over Year
Front desk staff play an important role in ensuring optimized reimbursement. From collecting at the time of visit to complete and accurate patient information, front desk performance will impact your bottom line. Despite changes in healthcare and increasing patient responsibility, front desk collections remained relatively consistent from 2014 through 2018.
Of the $124 average reimbursement per visit received from 2014 through 2018, an average of $25 was collected at the time of service. Front desk reimbursement was the highest, $26, in 2018.
IN THIS SECTION Average Front Desk Collections Year Over Year Percent of Collections at the Front Desk by Visits and Payments Year Over Year
FIGURE M. Average Front Desk Collections Year Over Year $140 120 100 80 60 40 20 0 2014 $122 2015 $124 2017 $125 2016 $122 2018 $126 $25 $24 $25 $24 $26 $97 $99 $100 $98 $100 Collected at Front Desk Collected at Another Time
Issue 08 Winter 2019
Urgent Care Trends: A Five-Year Retrospective
Of the total reimbursement received, approximately 20 percent was received at the front desk at the time of service. The remaining 80 percent was collected at another time. This ratio has remained fairly consistent over the past five years. On average, a payment was collected at the time of service in 52 percent of visits.
FIGURE N.
Year Over Year 60% 50 40 30 20 10 0 55 53 50 51 51 21 20 20 20 2014 2015 2016 2017 2018 20 % Visits with Payment Collected at Time of Service % Payments Collected at Time of Service
Percent of Collections
at the Front Desk
by Visits and Payments
Flu Diagnoses 2014–2018
Historically, the length and severity of flu season has had a big effect on the urgent care industry. So far, this flu season has been milder than last year’s. Here’s a look at flu season over the last five years.
Urgent Care Trends: A Five-Year Retrospective
In the last five years, 2017-2018 was by far the most severe flu season. The season peaked in January when 13.4 percent of visits included a flu diagnosis. During that flu season (from July 2017-June 2018) more than four percent of visits included a flu diagnosis, compared to about two percent in previous years.
NOTE:
*Urgent care visits only. Seasons are defined as July through June, so 2013-2014 includes July through December, 2013.
Issue 08 Winter 2019
THIS SECTION Percent of Visits with Flu Diagnosis Year Over Year Percent of Seasonal Visits with Flu Diagnosis Year Over Year
IN
FIGURE O.
of Visits
Flu
Year Over Year* 16% 14 12 10 8 6 4 2 0 2017–2018 2013–2014 2015–2016 2018–2019 2016–2017 2014–2015 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Percent
with
Diagnosis
Urgent Care Trends: A Five-Year Retrospective
Metrics Matter
Urgent care metrics are the vital signs for your urgent care clinic. Measuring KPIs and using them to make adjustments to your business helps to keep your clinics healthy and performing at top capacity. Be sure you know your current metrics and compare them to reliable data to improve your performance in 2019 and beyond.
Get reliable urgent care data from Experity.
If you want to get even more clinical, operational, and financial clarity from your EMR, explore our business intelligence solution.
NOTE:
*Includes the same data as Figure O but with a closer look at November through March—historically the most common months for flu diagnosis.
Issue 08 Winter 2019
FIGURE P.
16% 14 12 10 8 6 4 2 0 November 1 2 1 1 2 1 December 6 8 1 2 7 3 January 6 7 1 4 13 February 3 5 4 8 12 March 1 3 5 5 4 2017–2018 2013–2014 2015–2016 2018–2019 2016–2017 2014–2015
Percent of Seasonal Visits with Flu Diagnosis Year Over Year*
COMING SOON Issue 09 Coming Soon DOWNLOAD DOWNLOAD THIS ISSUE Issue 06 Summer 2018 An Analysis of Employer Services in Urgent Care Over Five Years Issue 07 Fall 2018 Urgent Care Antibiotic Prescribing Issue 08 Winter 2019 Urgent Care Trends: A Five-Year Retrospective Don’t miss an issue. Subscribe now or download a back issue below. SUBSCRIBE
About Experity
Experity is a dynamic HIT company that provides integrated technology solutions to more than 4,000 on-demand healthcare practices, primary care clinics, diagnostic testing centers, and health systems nationwide. With a mission to power patient-centered care, the company’s focus is all urgent care, all the time. Its complete suite of software and services includes EMR and PM, patient engagement, teleradiology, business intelligence, consulting, and billing solutions. The company was formed through the merger of the leaders in urgent care technology, DocuTAP and Practice Velocity. A Warburg Pincus portfolio company, Experity is a fast-paced, high-growth company committed to improving on-demand healthcare for everyone.
NOTE:
This resource was first published prior to the 2019 merger between DocuTAP and Practice Velocity. All data analyzed for this publication was pulled from DocuTAP’s database.
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